Impact of a Three-Week in-Hospital Multidisciplinary Body Weight Reduction Program on Body Composition, Muscle Performance and Fatigue in a Pediatric Obese Population with or without Metabolic Syndrome.

Antonello Emilio Rigamonti,Silvano G Cella,Sofia Tamini,Antonella Saezza,Alessandra De Col,Alessandro Sartorio,Roberta De Micheli,Gabriella Tringali

doi:10.3390/nu12010208

Abstract

Metabolic syndrome is a combination of cardiometabolic risk factors, frequently detected in obese children and adolescents. To date, few clinical studies have evaluated the effectiveness of multidisciplinary body weight reduction programs on body mass index, body composition, muscle performance and fatigue in pediatric obese subjects suffering from metabolic syndrome, which might represent a sub-population that is more difficult to be treated and worthy of more intensive interventions than a population less metabolically complicated. The aim of the present study was to compare the impact of a three-week in-hospital multidisciplinary integrated body weight reduction program (BWRP) on body mass index (BMI), body composition (particularly, fat mass (FM) and fat-free mass (FFM)), motor control (evaluated by one-leg standing balance (OLSB) test), muscle performance (evaluated by the stair climbing test (SCT)) and fatigue (evaluated by fatigue severity scale (FSS)) in a pediatric obese population with or without metabolic syndrome. A pediatric population of 548 obese subjects without metabolic syndrome (F/M = 312/236; age range: 8–18 years; BMI: 36.3 ± 6.7 kg/m2) and 96 obese subjects with metabolic syndrome (F/M = 53/43; age range: 9–18 years; BMI: 38.3 ± 6.9 kg/m2) was recruited. The BWRP significantly reduced BMI, FM (expressed as %), SCT time and FSS score, and increased OLSB time in all subgroups of obese subjects, independent of sex and metabolic syndrome, with preservation of FFM. No significant differences in |ΔBMI|, |ΔFM|, |ΔOLSB| or |ΔSCT| times and |ΔFSS| score were found when comparing subjects (males and females) with or without metabolic syndrome, apart from obese females without metabolic syndrome, who exhibited a lower weight loss and FM (expressed as %) reduction when compared to the corresponding male counterpart. In conclusion, the beneficial effects of a three-week BWRP on BMI, body composition, muscle performance and fatigue in a pediatric obese population were not found to be different in patients with or without metabolic syndrome, thus indicating that the more metabolically compromised patient is as responsive to a short-term BWRP as the patient without metabolic syndrome. More prolonged follow-up studies are, however, necessary in order to verify whether the adherence to the multidisciplinary recommendations at home and the long-term maintenance of the positive effects in the two subgroups of patients will remain similar or not.

Highlights

Pediatric obesity represents an increasingly serious problem of public health in both developed and developing countries [1,2]
Demographic, clinical and biochemical parameters of the recruited pediatric obese population are reported in Table 1, which includes the statistical significance of the possible comparisons among groups/subgroups
Weight, body mass index (BMI), waist, waist to hip ratio (WHR), glucose, triglycerides, heart rate (HR) and systolic BP (SBP) were significantly lower in obese subjects without metabolic syndrome than those with metabolic syndrome (p < 0.05)

Summary

Introduction

Pediatric obesity represents an increasingly serious problem of public health in both developed and developing countries [1,2]. Metabolic syndrome is a combination of different cardiometabolic risk factors, including abdominal adiposity, hypertension, dyslipidemia and hyperglycemia, associated with atherosclerosis, cardiovascular diseases, non-alcoholic fatty liver disease, type 2 diabetes mellitus and cerebrovascular diseases [3]. This nosographic picture, previously diagnosed uniquely in obese adults, is frequently recognized in obese children and adolescents, for whom specific diagnostic criteria have been elaborated [4,5]. Early adoption of large-scale healthy lifestyle changes and therapeutic interventions, including multidisciplinary integrated body weight reduction programs (BWRP), is fundamental for controlling the pandemic problem of pediatric obesity and, more importantly, to arrest the progression of metabolic syndrome [7]. As severely obese subjects are generally more difficult to treat through a standardized BWRP [9], one might argue that an obese subject with metabolic syndrome will respond less to a BWRP (or other therapeutic interventions) when compared to an obese subject without metabolic syndrome

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